Organization
ELLIS D. BRAUD AND FRED A. TENNEY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELLIS DAVID BRAUD JR. DDS (PRESIDENT)
(985) 446-2888
Entity
Organization
Contact information
Practice address
810 BAYOU LN, THIBODAUX, LA 70301-4906
(985) 446-2888
(985) 447-1007
Mailing address
810 BAYOU LN, THIBODAUX, LA 70301-4906
(985) 446-2888
(985) 447-1007
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
29215
—
LA
05
—
29633
—
LA
Enumeration date
05/24/2017
Last updated
07/21/2022
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